Abstract
Background
The incidence of post-transplant diabetes (PTDM) is variable primarily due to a lack of standardised diagnostic criteria.
Aim
This study aimed to assess the incidence of PTDM in heart and lung transplant (HLT) patients and to review if the management of these patients is in accordance with the 2014 American Society of Transplantation guidelines.
Methods
This was a retrospective study in the Mater Misericordiae University Hospital, Dublin, Ireland. Data was collected from the patients who had undergone HLT.
Results
All patients who had a heart and/or lung transplant between 2005 and 2017 were identified. The majority of our patients had lung 111 (53.9%), heart 94 (45.6%) and combined heart/lung 1(0.5%) transplants. A total of 174 (84.5%) patients were screened for diabetes pre-transplantation. Two hundred five (99.9%) patients were screened for PTDM post-surgery. The cumulative incidence for PTDM was 19.4% (40/206). All patients with PTDM were on prednisolone, 32 (80%) on tacrolimus and 4 (10%) on cyclosporine.
Conclusions
The cumulative incidence of post-transplant diabetes in our cohort was 19.4%. The majority of the patients were screened before and after transplant for glucose abnormality. The authors recommend that all patients should be managed in a multidisciplinary setting including transplant physicians, endocrinlogist, diabetes nurse specialists, transplant nurses and dietitians.
Similar content being viewed by others
References
Kasiske BL, Snyder JJ, Gilbertson D, Matas AJ (2003) Diabetes mellitus after kidney transplantation in the United States. Am J Transplant 3(2):178–185
Reisaeter AV, Hartmann A (2001) Risk factors and incidence of posttransplant diabetes mellitus. Transplant Proc 33(5A Suppl):8S–18S
Davidson J, Wilkinson A, Dantal J et al (2003) New-onset diabetes after transplantation: 2003 International consensus guidelines. Proceedings of an international expert panel meeting. Barcelona, Spain, 19 February 2003. Transplantation 75(10 Suppl):SS3–S24
Stratton IM, Adler AI, Neil HA et al (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 321(7258):405–412
Chaturvedi N, Bandinelli S, Mangili R, Penno G, Rottiers RE, Fuller JH (2001) Microalbuminuria in type 1 diabetes: rates, risk factors and glycemic threshold. Kidney Int 60(1):219–227
Fowler MJ (2008) Microvascular and macrovascular complications of diabetes. Clinical Diabetes 26(2):77–82
Burroughs TE, Swindle J, Takemoto S, Lentine KL, Machnicki G, Irish WD, Brennan DC, Schnitzler MA (2007) Diabetic complications associated with new-onset diabetes mellitus in renal transplant recipients. Transplantation. 83(8):1027–1034
Moore R, Ravindran V, Baboolal K (2006) The burden of new-onset diabetes mellitus after transplantation. Clin Transpl 20(6):755–761
Sharif A, Hecking M, de Vries AP et al (2014) Proceedings from an international consensus meeting on post transplantation diabetes mellitus: recommendations and future directions. Am J Transplant 14(9):1992–2000
Mazali FC, Lalli CA, Alves-Filho G, Mazzali M (2008) Posttransplant diabetes mellitus: incidence and risk factors. Transplant Proc 40(3):764–766
Park SC, Yoon YD, Jung HY, Kim KH, Choi JY, Park SH, Kim CD, Kim YL, Kim HK, Huh S, Cho JH (2015) Effect of transient post-transplantation hyperglycemia on the development of diabetes mellitus and transplantation outcomes in kidney transplant recipients. Transplant Proc 47(3):666–671
Hecking M, Haidinger M, Döller D, Werzowa J, Tura A, Zhang J, Tekoglu H, Pleiner J, Wrba T, Rasoul-Rockenschaub S, Mühlbacher F, Schmaldienst S, Druml W, Hörl WH, Krebs M, Wolzt M, Pacini G, Port FK, Säemann MD (2012) Early basal insulin therapy decreases new-onset diabetes after renal transplantation. J Am Soc Nephrol 23(4):739–749
Woodward RS, Schnitzler MA, Baty J, Lowell JA, Lopez-Rocafort L, Haider S, Woodworth TG, Brennan DC (2003) Incidence and cost of new onset diabetes mellitus among U.S. wait-listed and transplanted renal allograft recipients. Am J Transplant 3(5):590–598
Lindholm A, Albrechtsen D, Frödin L, Tufveson G, Persson NH, Lundgren G (1995) Ischemic heart disease--major cause of death and graft loss after renal transplantation in Scandinavia. Transplantation. 60(5):451–457
Johnston SD, Morris JK, Cramb R, Gunson BK, Neuberger J (2002) Cardiovascular morbidity and mortality after orthotopic liver transplantation. Transplantation. 73(6):901–906
Jindal RM, Sidner RA, Milgrom ML (1997) Post-transplant diabetes mellitus. The role of immunosuppression. Drug Saf 16(4):242–257
Cosio FG, Kudva Y, van der Velde M, Larson TS, Textor SC, Griffin MD, Stegall MD (2005) New onset hyperglycemia and diabetes are associated with increased cardiovascular risk after kidney transplantation. Kidney Int 67(6):2415–2421
Ghisdal L, Van Laecke S, Abramowicz MJ, Vanholder R, Abramowicz D (2012) New-onset diabetes after renal transplantation: risk assessment and management. Diabetes Care 35(1):181–188
Vincenti F, Friman S, Scheuermann E, Rostaing L, Jenssen T, Campistol JM, Uchida K, Pescovitz MD, Marchetti P, Tuncer M, Citterio F, Wiecek A, Chadban S, el-Shahawy M, Budde K, Goto N, on behalf of the DIRECT (Diabetes Incidence after Renal Transplantation: Neoral® C2 Monitoring Versus Tacrolimus) Investigators (2007) Results of an international, randomized trial comparing glucose metabolism disorders and outcome with cyclosporine versus tacrolimus. Am J Transplant 7(6):1506–1514
Cosio FG, Larson TS (2003) Cardiovascular disease after transplantation: do we know all of the variables? Am J Transplant 3(8):915–916
James PA, Oparil S, Carter BL et al (2014) 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC). JAMA 311(5):507–520
Acknowledgements
The authors would like to thank the patients involved in this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kgosidialwa, O., Blake, K., O’Connell, O. et al. Post-transplant diabetes mellitus associated with heart and lung transplant. Ir J Med Sci 189, 185–189 (2020). https://doi.org/10.1007/s11845-019-02068-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-019-02068-7